Monday, March 31, 2014

The easier paths

I worked with a stroke patient at one facility. The MD had left a gastric enteral feeding tube in place even though he was eating as the patient was not expected to improve much. He began standing with nursing staff at bedside by pulling on the bedside rail. He then worked worked with several of the therapy staff who had not had extensive stroke rehab experience. I did not either but had much more than the other therapists for stroke rehab. When I started working with him he was very unbalanced, and unable to transfer without two people assisting. After several months of us working together he was able to leave the facility. He was walking a couple hundred feet with a quad cane and was able to manage minor steps up and down stairs. I was never able to help him become fully independent with standing without use of the rail however. It was hit and miss, with me usually giving tactile cues, as he did not need the physical assistance as much as the guidance. Most of the people who assisted him in his daily tasks used the rail to facilitate his transfers for increased safety. There is a debate in rehab with those who a employ a pure "neurologically" based rehab and those who are more generalists in the way they progress patients. The problem of letting a patient cheat and use the rail to stand at first by pulling with their good arm is that they become very good at standing in that pattern. If a rail is not around they can lose the ability to rise their body above their feet. My feeling if I was a better more experienced therapist I could have helped him more with coming to stand independently as I would have been better at finding the key that would have led to the understanding that he needed.

In my own movements I feel once a efficient moving pattern is established it can become habitual. Once habitual if I want to change what I am doing I have to recognize what I am already doing. How I find what I am doing often is far more challenging than the actual change. The simple act of me looking for another person's right eye I believe established my habitual head postural position. It exists whether or not another person is there for me to relate to. I was not looking for this 'understanding" of my eye influence on my head but found it more by accident after many years of following other cues provided by studying the works of Moshe Feldenkrais. I believe I did not relate to the left half of people's faces in my past. Now I often consciously look for it first and it allows me to feel the difference between my usual and what I am trying. As I pay attention to the discrepancy, what I usually do becomes clearer in it's artificiality. It is still my normal mode of moving and relating to people by a vast margin..

I have always had the view that I have one tongue and throat with two sides now I feel I have both a left and right tongue and a left and right throat. To be more exact the musculature of my left under tongue and my left anterior throat had no sense of differentiation. I could not access that area to relax what it was doing habitually. Now it feels I have some control and it immediately relates to how I use my posterior head and upper and lower back musculature. At this point I am not able much to change how I usually function as with my former patient my predominate habits are the much easier paths.